According to the Joint Committee on Cancer, the 10-year survival rates for stages I, II, III, and IV medullary thyroid cancer (MTC) are 100%, 93%, 71%, and 21%, respectively. Guidelines from the American Thyroid Association (ATA) and the North American Neuroendocrine Tumor Society recommend that standard treatment for clinical MTC consist of total thyroidectomy with prophylactic central lymph node dissection. To understand if this “one-size-fits-all” surgical approach to MTC is effective, Nazanene H. Esfandiari, MD, and colleagues conducted a study of nearly 3,000 patients with MTC. “We wanted to understand the factors that were associated with worse survival, including the role of more versus less extensive surgery,” she says. Disease Severity & Extent of Resection Dr. Esfandiari and colleagues gathered data from the National Cancer Database on patients who were diagnosed with MTC between 1998 and 2005. “Disease severity was characterized by the size of the tumor, the number of cervical lymph node metastases, and the presence or absence of distant metastases,” says Dr. Esfandiari. “We looked at the relationship between tumor characteristics, patient characteristics, and the extent of surgery with regard to overall survival.” Tumors were categorized into those that were 1.0 cm or smaller, 1.1 cm to 2.0 cm, 2.1 cm to 4.0 cm, more than 4 cm, or unknown. Interventions compared in the study included total thyroidectomy, lobectomy, and no surgery. Cervical lymph nodes were grouped as follows: one to five, six to 10, 11 to 15, and 16 or more positive nodes. “We found that the overall survival rate was about 89% for patients with tumors sized 2 cm or smaller and no distant metastases,”...